Multiple clip applier apparatus and method

ABSTRACT

A surgical clip applier includes a train of clips disposed in a plane with a single clip removed from the train of clips and disposed in a staging position. A pair of jaws are adapted to receive the single clip from the staging position by operation of a jaw loader moveable outside the plane of the train of clips. In an associate method, a handle assembly is provided which is moveable in an open stroke and a closed stroke. A source of surgical clips are provided along with a pair of jaws which are adapted to receive one of the clips as the handle assembly is moved in an open stroke, the jaws are open to receive the clip. Following the opening of the jaws, a jaw loader is extended to a position between the jaws to move the clip into the jaws. The handle assembly is moveable in a closed stroke during which the jaws are closed to crimp the clip. Prior to this closing of the jaws, the jaw loader is retracted from the position between the jaws leaving the clip in the jaws.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.10/381,970, entitled “MULTIPLE CLIP APPLIER APPARATUS AND METHOD,” whichentered the national stage under 35 U.S.C. §371 on Mar. 5, 2004,currently pending, which is a national stage entry of PCT ApplicationNo. PCT/US01/31160, entitled “MULTIPLE CLIP APPLIER APPARATUS ANDMETHOD,” filed Oct. 4, 2001, which claims the benefit of U.S.Provisional Application Ser. No. 60/238,723, entitled “MULTIPLE CLIPAPPLIER APPARATUS AND METHOD,” filed on Oct. 6, 2000. Each of theseapplications is incorporated by reference in its entirety.

Related subject matter can be found in PCT application No.PCT/US00/01296 filed on Jan. 19, 2000 and entitled “Modular LigatingApparatus and Method”, and also U.S. Provisional Patent Application No.60/117,079 filed on Jan. 25, 1999 and entitled: “Modular LigatingApparatus and Method.” Each of these applications is incorporated byreference in its entirety.

BACKGROUND OF THE INVENTION

Clip appliers of the past have included cartridges containing multipleclips. These cartridges have been automatically actuated and accordinglyhave not offered the tactical feedback desired by surgeons. In addition,automatic clip appliers have been exceedingly complex typicallyrequiring not less than 22 moving parts. Tactical feedback isappreciated as it gives a surgeon some indication as to the amount offorce being applied by the clip to the body tissue, such as a bloodvessel. Only single clip appliers have provided this tactical feedback.

Multiple clip appliers have used jaw loaders to individually load eachclip, into the jaws of the applier. Removing the jaw loaders frombetween the jaws prior to crimping the clip has sometimes resulted injamming.

SUMMARY OF THE INVENTION

In accordance with the present invention, a multiple clip applier isdisclosed which provides a high degree of tactical feedback with onlysix moving parts. The resulting applier provides the desired feedbackwith a relatively simple mechanisms and a high degree of reliability.

A mechanical delay circuit is disclosed which loads a clip only in thelast five (5) percent of the opening stroke and removes the clip loaderin the first five (5) percent of the closing stroke. These steps ofloading and removing are accomplished in a positive, substantiallyinstantaneous manner. The resulting efficiency, reliability,disposability, alignment, tactical feedback, and repeatable operationcan all be appreciated within the scope of this invention.

These and other features and advantages of the invention will be betterunderstood with a description of preferred embodiments and reference tothe associated drawings.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a top-side perspective view of one embodiment of the clipapplier of the present invention;

FIG. 2 is a bottom side perspective view of the clip applier illustratedin FIG. 1;

FIG. 3 is an exploded view of the clip applier showing a disposable clipcartridge removed from a snap-fit relationship with a handle assembly;

FIG. 4 is an exploded view of one embodiment of the cartridge associatedwith the present invention;

FIG. 5 a is a top-side perspective view of a clip train and clipadvancer mechanism;

FIG. 5 b is a time line showing the sequence of operation in a preferredembodiment of the invention;

FIG. 6 is a top-side perspective view of a slide block retractor and jawloader mechanism relatively positioned at the beginning of a retractionstage;

FIG. 7 is a top-side perspective view of the retractor slide block andjaw loader showing the jaw loader in a retracted position;

FIG. 8 is a top-side perspective view of the retractor slide block andjaw loader, each in its retracted position;

FIG. 9 is a top-side perspective view showing the retractor, slide blockand jaw loader at a late stage in the closing strokes;

FIG. 10 is an axial cross section view of the slide block and jaw loaderat the stage illustrated in FIG. 9;

FIG. 11 is an axial cross section view similar to FIG. 10 and showingthe slide block releasing a keeper to initiate advancement of the jawloader;

FIG. 12 is a top-side perspective view showing the slide block and jawloader at a late stage in the opening stroke; and

FIG. 13 is a top/slide perspective view showing the slide block and jawloader at an ultimate stage of the opening stoke;

FIG. 14 is a perspective view of a clip loading arrangement including aclip staging position; and

FIG. 15 is a perspective view of a further embodiment of a clip loadingarrangement.

DESCRIPTION OF PREFERRED EMBODIMENTS

A multiple-clip clip applier of the present invention is illustrated inFIG. 1 and designated by the reference numeral 10. The clip applier 10includes a disposable cartridge 12, and a non-disposable handle assembly14 which can be coupled to the cartridge 12 in a snap-fit relationshipas illustrated in FIG. 1 At a distal end 16 of the applier 10, thecartridge 12 is provided with metal jaws 18 which are disposable withthe cartridge 12. The jaws 18 are biased to an open state but moveableto a closed state. The handle assembly 14 has a scissors configurationand a pair of pawls 21 at the distal end 16 which can be moved togetherto close the jaws 18, and can be moved apart to permit the jaws 18 toopen. The self alignment of the jaws 18 is of particular advantage tothe present invention and generally guaranteed with the replacement ofeach disposable cartridge 12. This self alignment of the jaws 18 isdisclosed in greater detail in PCT Application Serial No.PCT/US00/01216. This alignment of the jaws 18 is independent of thealignment or misalignment of the pawls 21 as disclosed in greater detailin U.S. Patent Application Ser. No. 60/117,079. This latter applicationalso discloses operation of the handle assembly 14 which includes a pairof converging slots 23 and 25, best illustrated in the bottom view ofFIG. 2. The handle assembly 14 is operable like a pair of scissors withan opening stroke and a closing stroke. A button 27 rides within theconverging slots 23, 25 between a distal position associated with theend of the opening stroke and a proximal position associated with theend of the closing stroke.

The cartridge 12 in this embodiment is snap-fit to the handle assembly14 at a fulcrum 29 and also through a cartridge drive pin 30 at thebutton 27. This snap-fit relationship is best illustrated in theassembly view of Figure.

FIG. 4 shows an exploded view of the cartridge 12 which in this caseincludes a bottom housing 32, a top housing 34 with a platform 35, and ahousing cap 36. The bottom housing 32 includes a clip train channel 38and a pair of upstanding walls 41 terminating proximally in a ballhousing 43 and a wall 45. The bottom housing also includes a keeper 47,having a pair of ramped actuators 50. A pair of inclined elements 52 arealso provided along with distal walls 54 and a drive pin slot 56.

The cartridge 12 is initially assembled by placing a plurality of clips57 into the channel 38. In this embodiment, the clips 57 are alignedend-to-end to form a clip train 59. The clip train 59 is biased in thedistal direction by a clip advancer 61 which rides within the channel38. The advancer 61 moves along a rod 63 and is biased distally by aspring 65. At the proximal end of the rod 63, a ball or enlargement 67is formed and seated in a fixed relationship with the ball housing 43.

A retractor 70 moves along the bottom housing 32 and includes anupstanding tab 72, a pair of abutments 74, an inclined tab 76, a drivepin slot 78, and a tongue 81 extending from a pair of shoulders 83. Acompression spring 85 is mounted on the tongue 81 and is compressedbetween the shoulders 83 and the upstanding walls 54.

A slide block 90 is disposed over the retractor 70 and includes a pairof upstanding walls which define a longitudinal slot configured toreceive the inclined tab 76. A drive pin 94 is seated in the block 90and extends through the slot 78 in the retractor 70, as well as the slot56 in the bottom housing 32.

A jaw loader 101 is of particular interest to the present invention. Itincludes a distally extending tongue 103 terminating in a V-slot 105which is complimentary in shape to the clips 57. Proximally of thetongue 103, a tunnel 107 is formed over a slot 109 which is shaped toreceive the clip advancer rod 63. The tunnel 107 terminates at aproximal surface 111. Proximally of this surface 111, an axial slot 113extends to a proximal wall 115 which includes a spring tab 117.Outwardly of the slot 113, a pair of wings 121 and 123 are provided witha leaf spring configuration. In its assembled state, the tab 72 of theretractor 70 is disposed within the slot 113 distally of the wall 115.The jaw loader 101 is positioned distally of the slide block 90 with atension spring 125 disposed between the walls 92 and attached atopposite ends to the spring tab 117 on the jaw loader 101 and theinclined tab 76 on the retractor 70.

The top 34 registers with the bottom 32 to form a housing of thecartridge 12. The top 34 also provides the platform 35 to receive thejaws 18 and their associated alignment assembly 126 and jaw spring 127.The cap 36 forms a cover over this platform 35.

Operation of the cartridge 12 involves two generally separate andindependent mechanisms: (1) a continuous and ongoing mechanism foradvancing the clip train 59, and (2) a delay mechanism for loading thenext clip into the jaws.

The continuous and ongoing portion of this process is associated withthe clip advancer 61 as illustrated in FIG. 5 a. In this view, the train59 of clips 57 is urged distally by the clip advancer 61 which in turnis biased to move distally along the rod 63 by the spring 65. This biasof the clip train 59 continues generally independently of any otherfunction associated with the clip applier 10.

The remaining operation of the clip applier 10 is repetitive so one mustpick a point in the cycle to begin this discussion. For purposes ofdiscussion, it will be assumed that the process begins with a singleclip 57 disposed in the jaws 18 at the completion of the opening strokewhen the handles of the assembly 14 (FIG. 1) are maximally separated.This point is designated by the reference numeral 126 along a cycle timeline 128 illustrated in FIG. 5 b.

At this point in time, the jaw loader 101 is disposed at its distal mostposition where it extends between the jaws 18. The retraction spring 125is fully extended or stretched while the retractor spring 85 isgenerally uncompressed. With the handle assembly 14 maximally opened,the drive pin 94 associated with the slide block 90 is in its distalmost position.

In order to crimp the clip 57 and the jaws 18, the natural motion of thehandle assembly 14 is to move the handles together. Thus begins theclosing stroke at point 124 of the time line 126. As the handles of theassembly are brought into proximity, the pawls 21 push against the biasof the jaw spring 127 to close the jaws 18 and thereby crimp the clip57.

Before the clip 57 can be crimped however, the jaw loader 101 must beremoved from between the jaws 18. This is accomplished with the delaymechanism previously discussed, which responds almost immediately to theproximal movement of the drive pin 94 as shown by a point 128 in FIG. 5b. With reference to FIG. 6, it will be noted that when the drive pin 94moves proximally the slide block 90 is carried with it along with theretractor 70. The jaw loader 101 is also moved proximally due to itsengagement with the tab 72 of the retractor 70.

As this proximal movement continues, the wings 121 and 123 of the jawloader 101 ride up on the inclined elements 52 formed in the bottom 32of the housing. As the wings 121 and 123 ride up on the inclinedelements 52, the proximal wall 115 clears the abutments 74. This causesthe jaw loader 101 to snap proximally until the surface 111 associatedwith the tunnel 107 contacts the upstanding walls 41 of the bottom 32.Thus, at an early stage in the closing stroke, the jaw loader 101, andparticularly the tongue 103, is rapidly and positively withdrawn frombetween the jaws 18. The remainder of the closing stroke, beginning at apoint 129 for example, moves the pawls 21 against jaw 18 therebycrimping the up clip 57 to a point 130 in FIG. 5 b which represents theend of the close stroke and the beginning of the open stroke. Note thatapproximately 90 percent of the closing stroke is devoted to the tactilefeedback associated with crimping the clip 57 onto the tissue. As thehandle assembly 14 continues to be closed, the drive pin 94 is drawnproximally along with the retractor 70 thereby compressing the retractorspring 85. With the jaw loader 101 stopped by the walls 41, thecontinued proximal movement of the slide block 90 and retractor 70stretches the tension spring 125 to its maximum extent.

This completes the closing stroke of the process at the point 129,crimping the clip 57 onto the tissue. It is now desirable to open thejaws 18 in order to release the crimped clip, and to load a new clip 57into the jaws 18.

In order to open the jaws 18, the normal movement of the handle assemblyis to separate the handles in an opening stroke which, for a preferredembodiment, begins at the point 130 along the time line 126. At thebeginning of this stroke, when the handles of the assembly 14 areinitially moved apart, the drive pin 94 begins its distal movement.Approximately 95 percent of this distal movement is associated withspreading the pawls 21 so that the jaws can separate under the bias ofthe spring 127. As the handle assembly 14 continues to be open, thedrive pin is moved distally carrying the slide block 90 into proximitywith its distal most position. This point is designated by the referencenumeral 131 in FIG. 5 b. No other forces act on the slide block 90 untilit reaches the actuators 50 associated with the keeper 47.

As the handle assembly 14 is further opened and the slide block 90 isdriven further in the distal direction, the block 90 depresses theactuators 50 as well as the keeper 47. When the keeper 47 issufficiently depressed, the retractor 70 snaps distally, causing theabutments 74 to push against the proximal wall 115, forcing the cliploader 101 to move the next clip 57 into the jaws 18. It will be notedthat this movement of the next clip 57 is accomplished at the end of theopen stroke in a positive and instantaneous manner. This ensures thatthe jaws 18 are fully open and ready to receive the next clip 57 beforeit is moved into position. Only then does the retractor 70 respond tothe compression of the retractor spring 85 to move the jaw loader 101against the clip. As the jaw loader 101 is snapped distally, the wings121 and 123 are bent inwardly by the inclined elements 152 asillustrated in FIG. 12 until the wings 121, 123 clear the elements 152as illustrated in FIG. 13. This FIG. 13 is the same as FIG. 6 reflectingthat the process has been completed with a new clip 57 loaded in thejaws 18 and the clip loader 101 in its fully distal position. A point133 on the time line 126 designates the end of the open stroke.

The points along the timeline 126 can be further defined for a preferredembodiment of the clip applier 10. In this embodiment, it will be notedthat the pawls 21 of the handle assembly 14 are increasingly separatedin the open stroke until they reach a space relationship. The pawls 21are increasingly moved together in the closed stroke until they reach afully proximate position. As noted, the jaws 18 are biased to an openstate but are moveable to a closed state. In this embodiment, when thepawls 21 are in the fully spaced relationship, the jaws 18 are biased totheir open state. However, in this embodiment, the pawls 21 are openfurther in their fully spaced relationship than the jaws 18 in theiropen position. As a result, the handle assembly disengages and is spacedfrom the pawls 21 at the end of the open stroke and the beginning of theclosed stroke.

In operation, the point 124 on the timeline 126 is characterized in thisembodiment by the pawls 21 in the fully spaced relationship, the jaws 18in the open state, and the jaw loader 101 in the distal position betweenthe jaws 18. As the closed stroke begins, the point 128 is defined bythe jaws 18 in the open position, the clip between the jaws in the openstate and the jaw loader 101 retracted to the proximate position.Although the pawls 21 may have begun movement toward the closedposition, they have not yet engaged the jaws 18 in this particularembodiment.

At the point 129 on the timeline 126, the pawls 21 first engaged thejaws 18. Note that this point 129 follows the point 128 when the jawloader 101 was fully retracted. Between the points 129 and 130, thepawls 21 move the jaws 18 against their normal bias to their closed orfully proximate relationship. This of course, causes the clip 57 to becrimped. If it is desired that the clip 57 be left in a less than fullycrimped state, the jaw assembly 14 can be reversed between the points129 and 130 to disengage the clip 57 at its less than fully crimpedstate. With the clip applier 10 removed from the operative site, thehandle assembly 14 can close to the point 130 wherein the pawls 21 areat their fully proximate relationship and the jaws 18 are in theirclosed position.

As the open stroke begins at the point 130, the pawls 21 begin tospread, permitting the jaws 18 to separate under their own bias towardthe open position. Eventually, the jaws 18 reach their fully openposition, for example, at the point 131. Immediately following the point131, the pawls 21 disengage the jaws 18. In the remainder of the openstroke, the jaw loader 101 moves distally pushing before it the nextclip in the train 59.

Another aspect of the present invention is associated with operation ofthe clips 57 in the train 59. As noted, a continuous distal pressure isasserted on the back of the train 59 biasing the clips 57, by operationof the spring 65, in the distal direction. This moves the distal mostclip in the train 59 to a staging position where it is 1) elevated abovethe plane of the clip train 59. This is illustrated in greatest detailin FIG. 14 which shows a clip 130 loaded in the jaws 18, 2) a clip 132disposed in the elevated staging position above the train 59, and 3) aclip 134, the ultimate clip in the train 59. When the clip 130 leavesthe jaws 18, and the clip 132 advances into the jaws 18 and the clip 134moves into the staging position. In the staging position, the clip 132is held by a detent 137 which is then elevated by the jaw loader 101releasing the clip 132 and snapping the clip 132 into the jaws 18.

In a similar arrangement illustrated in FIG. 15, the clip train 59 isformed by clips 57 which are disposed in respective parallel planes. Inthis arrangement the clip loader 101 operates directly on the ultimateclip 57 to move that clip directly from the train 59 into the jaws 18.In this case, the clips 57 forming the train 59 can be joined by glue138 as illustrated in FIG. 15.

It will be understood that many other modifications can be made to thevarious disclosed embodiments without departing from the spirit andscope of the concept. For example, various sizes of the surgical deviceare contemplated as well as various types of constructions andmaterials. It will also be apparent that many modifications can be madeto the configuration of parts as well as their interaction. For thesereasons, the above description should not be construed as limiting theinvention, but should be interpreted as merely exemplary of preferredembodiments. Those skilled in the art will envision other modificationswithin the scope and spirit of the present invention as defined by thefollowing claims.

The invention claimed is:
 1. A surgical clip applier comprising: ahousing extending generally longitudinally from a proximal end to adistal end, the housing comprising a clip channel extending generallylongitudinally therein; a clip train comprising a plurality of clipspositioned in the clip channel; a handle assembly having an openposition and a closed position, and the handle assembly movable in aclosing stroke from the open position to the closed position and in anopening stroke from the closed position to the open position, and thehandle assembly positioned at the proximal end of the housing; a jawassembly comprising a first jaw and a second jaw, the jaw assemblypositioned at the distal end of the housing; a clip advancementmechanism configured to continuously and independently advance the cliptrain distally with respect to the housing; a delay mechanismoperatively coupled to the handle assembly for loading a distal-mostclip of the clip train into the jaw assembly, the delay mechanismcomprising: a slide block slidably positioned within the housing andoperatively coupled to the handle assembly such that the slide block istranslated proximally during the closing stroke and is translateddistally during the opening stroke; a retractor slidably positionedwithin the housing and biased longitudinally distally with respect tothe housing, the retractor operatively coupled to the slide block suchthat the retractor is translated proximally to a proximal positionduring the closing stroke; a jaw loader slidably positioned within thehousing, the jaw loader having a distal end configured to engage thedistal-most clip of the clip train, the jaw loader operatively coupledto the slide block such that proximal translation of the slide blockduring the closing stroke tends to translate the jaw loader proximally,and operatively coupled to the retractor such that distal translation ofthe retractor during the opening stroke advances the jaw loaderdistally; and a compression spring positioned within the housing betweenthe housing and the retractor such that the retractor is biased distallywith respect to the housing by the compression spring.
 2. The surgicalclip applier of claim 1, wherein the delay mechanism further comprises alatch to retain the retractor in the proximal position upon completionof the closing stroke, the latch releasable during distal translation ofthe slide block during the opening stroke.
 3. The surgical clip applierof claim 2, wherein the latch comprises: a keeper formed in the housingand engageable with the retractor in the proximal position; and at leastone actuator actuatable by the slide block to depress the keeper.
 4. Thesurgical clip applier of claim 1, wherein the jaw loader is operativelycoupled to the retractor by a tension spring.
 5. The surgical clipapplier of claim 1, wherein the retractor comprises an abutmentengageable with the jaw loader during the opening stroke.
 6. Thesurgical clip applier of claim 1, wherein the housing comprises aninclined tab and wherein the jaw loader comprises a wing positioned onthe inclined tab with the handle assembly in the open position and thewing advanceable over the inclined tab during the closing stroke.
 7. Thesurgical clip applier of claim 1, wherein the jaw loader comprises adistally extending tongue, and wherein the jaw loader is positionable ina distal most position such that the distally extending tongue in of thejaw loader extends between the first and second jaws.
 8. The surgicalclip applier of claim 7, wherein the housing comprises an upstandingwall extending therefrom and wherein the jaw loader comprises a proximalsurface that contacts the upstanding wall of the housing when the jawloader is moved proximally to a withdrawn position in which the tongueis withdrawn from between the first and second jaws.
 9. The surgicalclip applier of claim 1, wherein the retractor comprises a tongueextending from a pair of shoulders and wherein the compression spring ismounted on the tongue and applies compression force to the pair ofshoulders.
 10. The surgical clip applier of claim 1, wherein the clipadvancement mechanism comprises: a rod seated with respect to thehousing; a clip advancer slidable along the rod; and a spring biasingthe clip advancer distally along the rod.
 11. The surgical clip applierof claim 10, wherein the jaw loader comprises a tunnel formed therein,and wherein the rod of the clip advancement mechanism extends throughthe tunnel.
 12. A surgical clip applier comprising: a housing extendinggenerally longitudinally from a proximal end to a distal end, thehousing comprising a clip channel extending generally longitudinallytherein; a clip train comprising a plurality of clips positioned in theclip channel; a handle assembly having an open position and a closedposition, and the handle assembly movable in a closing stroke from theopen position to the closed position and in an opening stroke from theclosed position to the open position, and the handle assembly positionedat the proximal end of the housing; a jaw assembly comprising a firstjaw and a second jaw, the jaw assembly positioned at the distal end ofthe housing; a clip advancement mechanism configured to continuously andindependently advance the clip train distally with respect to thehousing; a delay mechanism operatively coupled to the handle assemblyfor loading a distal-most clip of the clip train into the jaw assembly,the delay mechanism comprising: a slide block slidably positioned withinthe housing and operatively coupled to the handle assembly such that theslide block is translated proximally during the closing stroke and istranslated distally during the opening stroke; a retractor slidablypositioned within the housing and biased longitudinally distally withrespect to the housing, the retractor operatively coupled to the slideblock such that the retractor is translated proximally to a proximalposition during the closing stroke; and a jaw loader slidably positionedwithin the housing, the jaw loader having a distal end configured toengage the distal-most clip of the clip train, the jaw loaderoperatively coupled to the slide block such that proximal translation ofthe slide block during the closing stroke tends to translate the jawloader proximally, and operatively coupled to the retractor such thatdistal translation of the retractor during the opening stroke advancesthe jaw loader distally; and wherein the handle assembly has a scissorconfiguration such that the handle assembly comprises a first handlepivotally connected to a second handle.
 13. The surgical clip applier ofclaim 12, wherein the handle assembly comprises: a first slot movable bythe first handle; a second slot movable by the second handle andconverging with the first slot; and a button positioned within theconverging slots and movable between a distal position at an end of theopening stroke and a proximal position at an end of the closing stroke;and wherein the slide block comprises a drive pin engageable in thebutton.
 14. A surgical clip applier comprising: a housing extendinggenerally longitudinally from a proximal end to a distal end, thehousing comprising a clip channel extending generally longitudinallytherein; a clip train comprising a plurality of clips positioned in theclip channel; a handle assembly movable in a closing stroke and anopening stroke, the handle assembly disposed at the proximal end of thehousing; a jaw assembly comprising a first jaw and a second jaw, the jawassembly positioned at the distal end of the housing, the jaw assemblyactuatable by the handle assembly between an open state in which thefirst jaw is spaced from the second jaw to receive a distal-most clip ofthe plurality of clips therebetween and a closed state in which thefirst jaw and the second jaw are positioned proximate one another tocrimp the clip positioned therebetween; a delay mechanism positionedwithin the housing for loading the distal-most clip of the plurality ofclips into the jaw assembly, the delay mechanism comprising: a slideblock slidably positioned within the housing and operatively coupled tothe handle assembly to slide proximally during the closing stroke andslide distally during the opening stroke; a jaw loader slidablypositioned within the housing, the jaw loader having a distal endconfigured to engage the distal-most clip of the clip train, the jawloader slidable to a distal-most position with the jaw assembly in theopen state in which the distal end of the jaw loader is positionedbetween the first jaw and the second jaw to load the distal-most clipinto the jaw assembly; and a tension spring coupling the jaw loader tothe slide block, the tension spring fully extended at the end of theopening stroke of the handle assembly and configured to rapidly withdrawthe jaw loader proximally during the closing stroke of the handleassembly; and wherein the closing stroke of the handle assemblycomprises: an initial removal stage in which the jaw loader is rapidlyslid proximally such that the distal end of the jaw loader is removedfrom between the first jaw and the second jaw of the jaw assembly by thetension spring wherein the handle assembly is disengaged from jawassembly during the removal stage such that the jaw assembly is notactuated during the removal stage; and a subsequent feedback stage inwhich the handle assembly is operatively coupled to the jaw assemblysuch that tactile feedback of crimping the clip positioned between thefirst and second jaws is transmitted to the handle assembly.
 15. Thesurgical clip applier of claim 14, wherein the feedback stage comprisesapproximately 90% of the opening stroke.
 16. The surgical clip applierof claim 14, wherein the removal stage comprises approximately 5% of theopening stroke.
 17. The surgical clip applier of claim 14, wherein theopening stroke of the handle assembly comprises: an opening stage inwhich the jaw assembly is moved from the closed state to the open state;and a loading stage in which the jaw loader is slid to the distal mostposition to load the distal-most clip of the clip train into the jawassembly.